Provider Demographics
NPI:1982660809
Name:WESTSIDE PODIATRY CENTER LLP
Entity Type:Organization
Organization Name:WESTSIDE PODIATRY CENTER LLP
Other - Org Name:SKANEATELES FOOT & ANKLE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LYNDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MURA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-546-0285
Mailing Address - Street 1:8132B OSWEGO RD
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13090-1500
Mailing Address - Country:US
Mailing Address - Phone:315-546-0285
Mailing Address - Fax:315-546-0289
Practice Address - Street 1:8132B OSWEGO RD
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13090-1500
Practice Address - Country:US
Practice Address - Phone:315-546-0285
Practice Address - Fax:315-546-0289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-21
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02554983Medicaid
NY02554983Medicaid
NY4885830001Medicare NSC